Best Practices

School Health Appraisal Programme

  • To assessing the health status of the students studying in band of JSS educational institutions which include, pre schools, primary and secondary schools, pre university colleges and degree colleges.
  • To provide on the spot treatment to the illnesses and to refer the students in the need of special care to higher centers.
  • To educate the students regarding prevention of illnesses, promotion of health.

The underlying principle of this programme is to identify preventable morbidities among adolescents and educate them regarding avoiding of these conditions.

The Context

School health is an important aspect of preventive medicine. There is an ample of evidence to prove that school health service is an economical and powerful means of raising community health and more importantly in future generations. The school health appraisal is a comprehensive health care of children that includes prevention of diseases, promotion of healthy lifestyle, treatment of ailments provided in a blended manner at an affordable cost. Common ailments among children of this age group include malnutrition, skin disorders, dental illnesses, mental illness, refractive errors, infections and infestations.

Most of these illnesses can be easily detected and treated at the earlier stages of their development so that the long term consequences can be avoided. Apart from posing danger to health of the child these illnesses can hinder their scholastic performance of the school children leading to the reduced socio economic output from them. This age group is a potential target for lifestyle interventions for ensuring their well being.

The Practice

Department of Community Medicine, JSS Medical College is undertaking annual school health appraisal programme for all the children studying in around 95 schools under JSS Mahavidyapeetha spread across four districts of South Karnataka, namely, Mysuru, Mandya, Chamarajanagara and Hassan. On an average around 15,000 school children receive benefit from this programme. A team from the Department consisting of, an Assistant Professor, Medico Social Worker, Post Graduate students, interns and attender visit schools as per a pre fixed schedule and undertake the exercise. Anthropometric measurements like, height, weight, chest circumference of all the children are assessed using standardized instruments. Refractive errors are assessed using Snellen’s charts designed in both English and Kannada language. Health check up of the children including general physical examination, Ear, Nose Throat examination, systemic examination like respiratory system, cardiovascular system, central nervous system, gastrointestinal system and genitor-urinary system are undertaken in a systematic way.

The detected ailments are treated on the spot and the conditions requiring specialized care are referred to the JSS hospital for further management. The referred children are followed up to know the outcome of health appraisal. This opportunity is also utilized to educate the school children on preventable morbidities, life style modification, nutrition, personal hygiene, menstrual hygiene, smoking, alcoholism, life skills etc. The children will get ample of opportunities to interact with interns, postgraduates and faculty from medical college. Apart from health related issues, aspects of healthful school environment like, location of school lighting, ventilation, types of desks, play ground, recreation facilities, maintenance of toilets, general sanitation, eating establishments are thoroughly assessed.

The data collected in school health card will be entered in MS Excel and analysed. The comprehensive report with conclusions and recommendations are communicated to the respective schools in a fortnight after the health check up. Swachh Bharat-Swachh Vidyalaya was a campaign for clean schools where the school children were educated on importance of cleanliness, how to reduce, reuse and recycle the waste generated in the schools and their homes. At the same time, the school teachers were also educated on the ways to involve school children in ensuring swachh bharat. Few research projects on heavy school bags, depression, suicidal tendencies among school children, assessment of adolescent obesity, student friendly school initiatives etc are undertaken.

Evidence of Success

Graph showing Coverage of school health programme in last five years

The school health programme has been a successful event since years. This is evidenced by sustained reduction in the preventable morbidities among school children. There is also improvement in the reporting rates of illnesses among the school children this is due to improved awareness regarding the illnesses. The acceptability of health appraisal has enormously improved over years which is evidenced by increasing demand being posed by the school authorities to undertake the exercise. Six articles on different dimensions of school health programme are published in peer reviewed journals. As a result of Swachh Bharat- Swachh school abhiyana, most of the schools have been declared as plastic free zones. The recommendations pertaining to healthful school environments have helped the school authorities make infrastructural modifications in the schools.

Problems Encountered and Resources Required

Gathering the adequate resources for conducting school health programme is a challenge. Establishment of sustainable referral loop for the children from schools to hospital needs to be strengthened. We are planning to have a comprehensive school health database of all the children under JSS Mahavidyapeetha for which the IT resources are essential. Modern equipments for checking refractive errors, cardiovascular diseases, colour blindness, learning disabilities are required for further strengthening of school health appraisal programme.

SMARAN Project

This is one of the largest community extension project implemented by JSS Medical College, Mysuru with the support of Dr Somashekhar and Mrs. Malthi Munavalli Health and Wellness Foundation.

Title of the Practice

Dr. Somashekhar and Mrs. Malathi Munavalli Health Awareness Project for Rural Areas of North Karnataka (SMARAN).

Objectives

  • To conduct and organize lectures, demonstrations and clinical screening on various health related problems such as heart diseases, diabetes, cancer, blood related problem etc by professionals and qualified experts
  • To prepare brochures and bulletins and other useful audiovisual aids on various diseases in simple language for free distribution among general public in large.
  • To create audiovisual aids for demonstration and exhibitions as often as necessary and needed to educate ordinary people.

The Context

Educating the community with prevailing health problems is listed as the first element of Primary health care concept in Alma Ata declaration. Health education is described as people in the community should be empowered with the enough knowledge on what the common health problems, what are the probable causes of them, the ways to overcome these problems and to do what individually and collectively to prevent the occurrence and spread of these health problems. Any health policy, programme or intervention will be successful, only if the people in the community are able to perceive the health problems, identify their health needs. Structured and sustainable health education activities concentrated on specific health problems will help in community empowerment on health needs and helps in converting the health needs into health demands. In this background JSS Medical College has undertaken the efforts to identify the remote villages in relatively background districts of Northern part of Karnataka and provide sustainable health education activities to achieve health awareness among people residing there.

The Practice

This sustainable community health awareness project is planned to be implemented in six districts of North Karnataka out of which four districts are covered so far. We established collaboration with local level community based Non Governmental Organization like Family planning Association of India and medical colleges. With the help of these agencies and district health administration, we have identified three to five most backward villages in each districts (which are devoid of health benefits and situated far away from district headquarter) for implementation of project activities. Based on the consultation with community leaders, villagers, health care authorities of the specific districts and sponsoring authorities, the final thrust areas for health education activities decided were, Hypertension, Diabetes, Anemia and issues related to MCH (Mother and Child health).

Health awareness materials like handouts and pamphlets in local language were prepared to deliver the health education messages. In order to achieve sustainability, local link worker empowerment approach was adapted. The model is identifying one highly motivated, service minded person from each of the villages (link worker) and training them on the thrust areas by a group of experts, in two contact sessions and intern utilizing them for delivering health education activities in the community. This model has helped us to solve most of the challenges mentioned in section 3, like aligning with socio-cultural milieu, establishing rapport with community, improve credibility and community mobilization. This model also helped us to reach the larger section of the community through the community participation.

Few innovative approaches in health education sessions adapted by the link worker are moon light shared dinner health awareness sessions, pregnant women honouring programme for mobilizing women for awareness sessions related to mother and child health issues. A good supportive supervision and monitoring mechanism is established where one supervisor from the local collaborative agency will visit the awareness sessions being delivered by the link worker and provides inputs for the performance. A team from JSS Medical College undertakes regular supervisory visits to monitor the project related activities.

Health camps are being conducted in these areas, to screen people for the common health related ailments and treatment is provided on the spot. The patients requiring specialized care are referred to district hospital for further management. This opportunity is also utilized for providing health education to the people on the thrust areas under the project. The camps have acted as tools for community mobilization for the awareness sessions.

Flow chart of activities

Evidence of Success

A total of 37646 people across 22 villages in four districts are covered under the project so far. 1827 health awareness sessions, involving seventeen village level link workers and 12 supervisory staff from the were conducted. 6511 people underwent health check up and received treatment in 33 health camps across these villages. 1752 school children across seven schools have also received health education through 97 sessions. The knowledge of villagers about the causes, symptoms, prevention and treatment of the diseases like hypertension, diabetes, anemia and MCH problems were found to be poor in the base line survey (survey conducted before educational interventions), the terminal survey results after series of health education activities have shown that there were significant improvement in the knowledge related to above mentioned domains.

Assessment of qualitative factors like acceptability of the awareness activities, attendance to the sessions, satisfaction with services, cooperation with link workers, participation in health camps, seeking care for these ailments have also improved over a period of time. Feedback from link workers also suggest that they feel empowered by the project and are able to help their villagers with their knowledge obtained through the project.

Problems Encountered

  • The project had to be implemented in Northern Part of Karnataka with it's administrative centre in Southern part of the state, Mysuru, which are situated almost 500 Kms apart. Thus it was difficult job to go there in- person and deliver the services by the team situated in the institution.
  • The second challenge was to get in tune with the socio-cultural specificities of the target population, especially the language, familial and community relationships, social structure, communication etc.
  • Gaining the confidence of the target population was the third important challenge. As the implementing institution is far away from the service zone and people were not aware of the community extension activities offered by our organization. This has raised the issue of credibility and acceptance of the project related activities and services.
  • Fourth challenge was mobilizing the people to accept the awareness messages and adapt them for positive behaviour change.

Resources required

Reaching larger section of population need more number of link workers and supervisors, but in rural areas getting such people is a difficult task. Sometimes link workers face difficulty in answering the queries raised by the villagers on these thrust areas, thus we are thinking of technology driven awareness sessions through interactive E gadgets, and telemedicine approaches. We are working towards locally tailored health education materials adapting the local language and culture which need larger intellectual inputs from experts and community. There is also a demand for increasing the number of health check up camps and increasing advocacy for the community mobilization.